Forty nine strains of Clostridum difficile (30 strains were isolated from patients with pseudomembranous colitis (PMC), 11 strains from patients without diarrhea, 8 strains from a hospital environment) were examined for polyacrylamide gel electrophoretic (PAGE) pattern by extracting their surface polypeptides using EDTA. These strains were classified into 6 groups (major type; type A, B, C, D, E, and minor type; type N: not typed) based on their PAGE patterns. Type N had 15 types of PAGE patterns. In total, there were 20 types of PAGE patterns among 49 strains of C. difficile. The group of type A was characterized by the major bands of molecular weights 54K and 37K, type B 57K, 40K, and 37K, type C 50K, 46K, and 36K, type D 50K, 38K, and 37K, and type E 54K and 42K, respectively. Using these typings, the colinzation of C. difficile in the colon of PMC-patients and the contamination of the environment by the fecal C. difficile were studied.
Twenty five out of 30 (83.3%) strains obtained from PMC-patients were classified into the major type, and only 6 out of 19 (31.6%) strains obtained either from patients without diarrhea or from the environment were grouped into the major type.
In 4 cases of PMC which showed remarkable improvement, there were no changes of the PAGE patterns of C. difficile between the isolates obtained in PMC-stage and in convalescent-stage within 4 weeks. In one case, the PAGE pattern changed from type A to type N along with the improvement of PMC after 4 months.
Among each of the 4 cases from which 10 colonies were arbitrarily picked up to be examined for the colonization of C. difficile in the colon, the PAGE patterns of the isolates were identical in 3 cases. In one case, two patterns (type C; 9 colonies, type E; 1 colony) were observed.
In 2 cases of PMC which were successfully treated with vancomycin, no changes of bacterial colonization in the colon were observed before and after treatment. In one case of peritoneal abscess, C. difficile was isolated thrice from the abscess and five times from the feces (10 colonies per each isolation) in 2 months. Thus, in total 53 isolates were collected. The PAGE patterns of 53 isolates were identical. The colonization of C. difficile in the colon was then seemed to be quite stable throughout the course of the disease. It may imply that relapses, which often occur when vancomycin is discontinued, are due to the endogenous C. difficile rather than to re-infection of the bacteria from the environment.
In the study of environmental contamination, ten strains of C. difficile were isolated from the patient with PMC and her ward. C. difficile with the same PAGE pattern as her strain's were isolated from the restricted area around the patient. It is, thus, considered that transmissions through the clinical staff should be kept in mind to prevent the nosocomial infection of PMC.

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We carried out the isolation of MRSA from materials of environment, medical staff as well as from patients' clinical specimens in the ICU of our hospital. We also performed the clinical and bacteriological characterization of MRSA isolates.
Upon investigation of environmental materials at 54 different floors, 2 (3.7%) isolates were recovered from 2 places. No MRSA was obtained from 60 different spots including surfaces of various equipments and attendant furnishings.
Among 24 medical staff, 5 staff, all of whom were nurses, were found to be positive for MRSA, and the freauencv of isolates among their materials was as follows: 5 (20.8%) isolates from the pharynx, 3 (12.5%) isolates from the nose and 1 (4.2%) isolate from the hand.
Of the 13 patients who showed S. aureus in clinical species, MRSA cases accounted for 11 patients (84.6%). When we evaluated clinical significance for these patients, 8 cases were of infection and the remaining 3 cases revealed colonization.
Analysis of bacteriological characterization of both environmental strains (including those from medical staff) and patients' strains revealed the following results. 1) The major types of coagulase and enterotoxin (SE) were type-II and SEC, respectively in both strains. 2) As for the production of Toxic Shock Syndrome Toxin-1, environmental and patients' strains showed positive in 5 (45.5%) and 16 (88.9%) strains, respectively. 3) Both strains showed the same and high susceptibilty against CP, TC, MINO and NFLX, and yet remarkable and multiple resistant against ABPC, 2 cephems, 3 aminoglycosides and CLDM. Furthermore, 3 strains (29.3%) of environmental strains and 9 (50.0%) of the patients' strains were assumed to be 4′, 4′′-adenylyl transfer enzyme-producing strains because these were sensitive to GM but resistant to TOB and AMK.
Based on the above results, two distinct patterns of MRSA seemed to exist and it was revealed that the distribution of environmental and patients' strains between these two patterns were different to each other. Thus, these results suggest that nosocomial infection in the ICU might take place.

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This is a detailed study of the aerobic and aneeobic bacteria from on the crypta tonsillaris and the parenchymatous tonisillaris of 12 patients sufering from habitual tonsillitis. Ninety-two strains from 19 species of aerobic bacteria and 60 strains from 22 species of anaerobic bacteria were isolated and identified from the tonsil surface, were 47 strains of 14 aerobic species and 24 of 10 aerobic species from the tonsil core. The bacteria detected were Streptococcus pyogenes, S. salivarius, S. sanguis, S. mitis, Branhamella catarrhalis, Haemophilis influenzae, Peptostreptococcus sp., Bacterioides sp., etc.
In each patient, an average of 12.7 species of bacteria were found on the crypta tonsillaris which consisted of 7.7 species of aerobic bacteria and 5 species of anaerobic bacteria. The amounts of bacteria found were 1.35×10⁶ CFU/ml and 0.93×10⁶ CFU/ml, respectively. In the tonsil core, an average of 6.3 species were detected with 3.9 being aerobic and 2.3 being anaerobic. The amount found were 0.93×10⁶ CFU/ml and 0.83×10⁶ CFU/ml, respectively.
Some strains of S. aureus, Branhamella, H. influenzae, Bacterioides melaninogenicus and B. oralis were able to synthesize β-lactamase.

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Enterobacter asburiae was the name proposed recently by Brenner et al. As the phenotypic characteristics of this species are similar to those of Enterobacter cloacae, it seems that clinical isolates of this species have been misidentified with the latter species in routine diagnostic work.
When 150 isolates from clinical specimens which had been identified as E. cloacae were reexamined using 38 physiological and biochemical tests, 7 strains were found to be E. asburiae. Biochemical characteristics of the 7 strains conformed to the description of E. asburiae by Brenner et al., with the exception of Voges-Proskauer reaction. Brenner et al. reported that the majority of their strains were negative in the Voges-Proskauer test. However, all the 7 strains studied here were positive by the Voges-Proskauer test. It seemed that discrepancies of the results in this feature was due to difference of media and methodology emplyoed.
Although significance of 6 of the 7 strains in the clinical specimens from which they were isolated were uncertain, its presence in one blood culture at least suggested clinical significance.

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Intravenous and intraperitoneal injections of slime from Acinetobacter calcoaceticus TMS266 induced leukopenia and death in mice. The leukopenia was characterized by a decrease in neutrophil count, followed by death of mice. This decrease of leukocytes was profound and supposed to contribute to the enhancement of virulence of other bacteria such as Escherichia coli. In mice treated with sublethal doses of the slime, the slime could not show its capacity to reduce circulating leukocytes.

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A measles outbreak occured in Tsubetsu, Hokkaido, between February and March, 1987. The outbreak was peculiar in that junior high school students mainly contracted measles. We investigated the cause of the outbreak of measles among adolescents with the cooperation of the elementary schools and the junior high schools in Tsubetsu, Tsubetsu Hospital and the regional health center in Bihoro. Five elementary school students and eighteen junior high school students contracted measles in Tsubetsu between February and March, 1987. On the other hand, the patients who were diagnosed as measles at Tsubetsu Hospital consisted of two infants, two elementary school students, eight junior high school students, three high school students and two adults.
In Tsubetsu, the rate of measles vaccination was 64.5 percent after the enforcement of the measles vaccination in 1979. The vaccination rate was too low to prevent measles outbreaks. We concluded that this low level of vaccination permitted the measles outbreak among adolescents who remained susceptible to measles.
It has been known that serum level of lactate dehydrogenase is increased in measles patients, and we reconfirmed it in this outbeeak. It might be helpful for atypical cases of measles.

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A 22-year old female was admitted to our hospital complaining of high fever and epigastric pain.
The laboratory data revealed eosinophilia (25%) and elevation of serum IgE (423 U/ml). CT scan and echogram showed multiple low density areas in both lobes of the liver. Laparoscopy demonstrated yellowish-white nodules on the surface of the liver, and the aspirated fluid obtained from the nodule showed Charcot-Lyden crystals. Parasite ova was detected neither in the bile nor in the feces.
Ouchterlony's double diffusion test of the patient showed a strong reaction against Fasciola hepatica antigen. The patient was administered Bithionol (2g/day) for 30 times, and showed improvement of clinical symptoms and laboratory abnormalities.

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A case of community acquired pneumonia due to Klebsiella pneumoniae (K. pneumoniae) associated with bacteremia and giant cavity on chest roentgenogram was reported.
A 52-year-old man was admitted to our hospital with complaints of fever, hemosputum, cough, and malaise. He had a history of heavy drinking and smoking, malnutrition due to irregular dietary habit, and diabetes mellitus. Chest roentgenogram on admission revealed a diffuse infiltration shadow in the left lung, and K. pneumoniae was isolated by TTA and blood culture. During the clinical course, a giant cavity with niveau was seen in the middle field of left lung on chest roentgenogram. K. pneumoniae was also isolated from the fluid obtained by puncture of the lung abscess, and the patient followed a satisfactory course by antibiotic therapy.
In recent years, K. pneumoniae pneumonia has been noted as one of the nosocomial infections. On the other hand, the present case was thought to be a classic one of K. pneumoniae pneumonia characterized by cavity formation occurring in middle aged heavy drinkers.

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We reported a case of systemic fungus-infection of Trichosporon beigelii in a leukemic patient. A 74 year-old male with myelodysplastic syndrome, who had been followed for four years, developed acute myelogeneous leukemia, and died despite chemotherapy. During the last granulocytopenic course complicated with stomatitis and fever, the blood culture of the patient yielded Candida albicans and T. beigelii. Postmortem examination revealed disseminated fungal infection (involving the liver. snleen, heart, kidneys, endocrine organs and nervous system). The causative organisms was immunohistochemically proven as T. beigelii in tissue sections.

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Emphysematous pyelonephritis is a rare but life-threatening infection of the renal parenchyma often complicated with diabetes mellitus and needs appropriate combination-therapy of antibiotics and surgical approach.
The authors experienced a 61-year-old female with uncontrolled diabetes mellitus who was admitted because of urinary tract infection due to Escherichia coli and Candida glabrata, which developed to cause septicemia and disseminated intravascular coagulopathy (DIC) by the former organism.
The patient was finally diagnosed as left emphysematous pyelonephritis by main reference to computed tomography with the help of other conventional image procedures, for example, intravenous pyelogram and Ga scintigram.
The patient received chemotherapy with cefmetazole 6 g daily (t. i. d.) for 25 days for E. coli and miconazole 400 mg daily (b.i.d.) for 18 days for C. glabrata as well as received adequate medications for diabetes mellitus and DIC concomitantly.
Following the medical treatment, left nephrectomy was performed which resulted in clinical improvement.

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We reported a case of Tsutsugamushi disease in Fukuoka prefecture where reports of Tsutsugamushi disease had not been reported till 1986.
A 38-year-old man was admitted to our hospital complaining of fever, skin rash and lymphadenopathy. Consciousness disturbance and interstitial pneumonia (on chest X-ray) were also observed. Eschar on the right side of the neck suggested Tsutsugamushi disease, and administration of doxycyline rapidaly improved clinical symptoms.
The sera of the patient in the convalescent period did not show elevation of antibody titer to Carp Kato and Gilliam strain of Rickettsia tsutsugamushi by indirect immunofluorescence method. The significant elevation of antibody titer was observed only to the Irie strain.

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A case of Tsutsugamushi disease found in Tokyo area was reported. Various cases of this disease have been endemic in the remote islands in Tokyo so far; however, this was the second case found in the metropolitan area. In addition, it was the first case from which Rickettsia tsutsugamushi was successfully isolated. The patient, 60 year-old-male, suffered from high fever of 38-40°C, severe headache and rash, and then was admitted to the local hospital at Itsukaichi-cho, Tokyo. By the recognition of eschar at the scabbed biting site, tsutsugamushi disease was suspected. By an indirect immunofluorescence (IF) examination conducted in our laboratory on April 22, 1987, the diagnosis was confirmed. Administration of minocycline quickly relieved the complaints of the patient.
R. tsutsugamushi was successfully isolated from the blood specimen taken after 22 days of onset by adopting the mouse intraperitoneal inoculation method. This was the first successful case of rickettsial isolation from a human who lived in the metropolitan area of Tokyo. The isolated R. tsutsugamushi proved to be related to the Karp strain by IF method using the sera from mice or guinea pigs immunized with it.

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